Type A and Type B personality theory describes two contrasting personality types that could either raise or lower, respectively, one's chances of developing coronary heart disease. There is considerable controversy about the role of these personality types in coronary heart disease and the role of tobacco industry funding of early research in this area.

Contents

Type A personality behavior was first described as a potential risk factor for heart disease in the 1950s by cardiologistsMeyer Friedman and Ray Rosenman. After an eight-and-a-half-year-long study of healthy men between the ages of 35 and 59, Friedman and Rosenman estimated that Type A behavior doubles the risk of coronary heart disease in otherwise healthy individuals.[1] The individuals enrolled in this study were followed well beyond the original time frame of the study. Subsequent analysis indicated that although Type A personality is associated with the incidence of coronary heart disease, it does not seem to be a risk factor for mortality.[2] This research had a significant effect on the development of the health psychology field, in which psychologists look at how an individual's mental state affects their physical health.[3]

The theory describes "Type A" individuals as ambitious, rigidly organized, highly status-conscious, sensitive, impatient, take on more than they can handle, want other people to get to the point, anxious, proactive, and concerned with time management. People with Type A personalities are often high-achieving "workaholics" who multi-task, push themselves with deadlines, and hate both delays and ambivalence.[4] It is therefore understood that "Type A" personalities are suited to smoking as a mechanism for relieving stress.

In his 1996 book, Type A Behavior: Its Diagnosis and Treatment, Friedman suggests that Type A behavior is expressed in three major symptoms: (1) free-floating hostility, which can be triggered by even minor incidents; (2) time urgency and impatience, which causes irritation and exasperation usually described as being "short-fused"; and (3) a competitivedrive, which causes stress and an achievement-driven mentality. The first of these symptoms is believed to be covert and therefore less observable, while the other two are more overt. [5]

The theory describes "Type B" individuals as a contrast to those with Type A personalities. People with Type B personality by definition generally live at a lower stress level and typically work steadily, enjoying achievement but not becoming stressed when they do not achieve. They may be creative and enjoy exploring ideas and concepts. They are often reflective.

Limitations of the original study comprise the inclusion of only middle-aged men and the lack of information regarding the diets of those subjects. While the latter could serve as a confounding variable, the former calls into question whether the findings can be generalized to the remaining male population or to the female population as a whole.

Friedman et al. (1986)[6] conducted a randomized controlled trial on 862 male and female post myocardial infarction patients, ruling out (by probabilistic equivalence) diet and other confounds. Subjects in the control group received group cardiac counseling, and subjects in the treatment group received cardiac counseling plus Type-A counseling. The recurrence rate was 28% in the control group and 13% in the treatment group, a strong and statistically significant finding.

Further discrediting the so-called Type A Behavior Pattern (TABP), a study from 2012 – based on searching the Legacy Tobacco Documents Library – suggests the phenomenon of initially promising results followed by negative findings to be partly explained by the tobacco industry’s involvement in TABP research to undermine the scientific evidence on smoking and health. The industry’s interest in TABP lasted at least four decades until the late 1990s, involving substantial funding to key researchers encouraged to prove smoking to simply correlate with a personality type prone to coronary heart disease (CHD) and cancer.[7] Hence, until the early 1980s, the industry’s strategy consisted of suggesting the risks of smoking to be caused by psychological characteristics of individual smokers rather than tobacco products by deeming the causes of cancer to be multifactorial with stress as a key contributing factor.[8][9][10] Philip Morris (today Altria) and RJ Reynolds helped generate substantial evidence to support these claims by funding workshops and research aiming to educate about and alter TABP to reduce risks of CHD and cancer. Moreover, Philip Morris primarily funded the Meyer Friedman Institute, e.g. conducting the “crown-jewel” trial on the effectiveness of reducing TABP whose expected findings could discredit studies associating smoking with CHD and cancer but failing to control for Type A behaviour.[7]

In 1994, Friedman wrote to the US Occupational Safety and Health Administration criticising restrictions on indoor smoking to reduce CHD, claiming the evidence remained unreliable since it did not account for the significant confounder of Type A behaviour, notwithstanding the fact that by then, TABP had proven to be significant in only three of twelve studies. Though apparently unpaid for, this letter was approved by and blind-copied to Philip Morris, and Friedman (falsely) claimed to receive funding largely from the National Heart, Lung and Blood Institute.[11] When TABP finally became untenable, Philip Morris supported research on its hostility component,[12] allowing Vice President Jetson Lincoln to explain passive smoking lethality by the stress exerted on a non-smoking spouse through media claiming the smoking spouse to be slowly killing themselves.[13] When examining the most recent review on TABP and CHD in this light, the close relationship to the tobacco industry becomes evident: of thirteen etiologic studies in the review, only four reported positive findings,[14] three of which had a direct or indirect link to the industry. Also on the whole most TABP studies had no relationship to the tobacco lobby but the majority of those with positive findings did.[7] Furthermore, TABP was used as a litigation defence, similar to psychosocial stress.[15] Hence, Petticrew et al. proved the tobacco industry to have substantially helped generate the scientific controversy on TABP, contributing to the (in lay circles) enduring popularity and prejudice for Type A personality even though it has been scientifically disproven.[7]

Some scholars argue that Type A behavior is not a good predictor of coronary heart disease.[16] According to research by Redford Williams of Duke University, the hostility component of Type A personality is the only significant risk factor.[17] Thus, it is a high level of expressed anger and hostility, not the other elements of Type A behavior, that constitutes the problem.

A study was performed that tested the effect of psychosocial variables, in particular personality and stress, as risk factors for cancer and coronary heart disease (CHD).[18] In this study, four personality types were recorded. Type 1 personality is cancer prone, Type 2 is CHD prone, Type 3 is alternating between behaviors characteristic of Types 1 and 2, and Type 4 is a healthy, autonomous type hypothesized to survive best. The data suggests that the Type 1 probands die mainly from cancer, type 2 from CHD, whereas Type 3 and especially Type 4 probands show a much lower death rate. Two additional types of personalities were measured, Type 5 and Type 6. Type 5 is a rational anti-emotional type, which shows characteristics common to Type 1 and Type 2. Type 6 personality shows psychopathic tendencies and is prone to drug addiction and AIDS.[19]

While most studies attempt to show the correlation between personality types and coronary heart disease, studies have suggested that mental attitudes constitute an important prognostic factor for cancer. As a method of treatment for cancer-prone patients, behavior therapy is used [20] The patient is taught to express his/her emotions more freely, in a socially acceptable manner, to become autonomous and be able to stand up for his/her rights. Behavior therapy would also teach them how to cope with stress-producing situations more successfully. The effectiveness of therapy in preventing death in cancer and CHD is evident.[21] The statistical data associated with higher death rates is impressive. Other measures of therapy have been attempted, such as group therapy. The effects were not as dramatic as behavior therapy, but still showed improvement in preventing death among cancer and CHD patients.

From the study above, several conclusions have been made. A relationship between personality and cancer exists, along with a relationship between personality and coronary heart disease. Personality type acts as a risk factor for diseases and interacts synergistically with other risk factors, such as smoking and heredity. It has been statistically proven that behavior therapy can significantly reduce the likelihood of cancer or coronary heart disease mortality. On the contrary, psychoanalysis can increase the likelihood of cancer and coronary heart disease mortality drastically (Citation need. This has no supporting evidence). Studies suggest that both body and mental disease arise from each other. Mental disorders arise from physical causes, and likewise, physical disorders arise from mental causes. While Type A personality did not show a strong direct relationship between its attributes and the cause of coronary heart disease, other types of personalities have shown strong influences on both cancer-prone patients and those prone to coronary heart disease.[21]

Maintaining healthy magnesium levels in the body plays a strong role in protecting the cardiovascular health of an individual. An analysis of the literature suggests the possible role of Mg deficiency in the susceptibility to cardiovascular diseases, observed among subjects displaying a type A behavior pattern. Experimental data which support this hypothesis are reviewed. Type A subjects are more sensitive to stress and produce more catecholamines than type B subjects. This, in turn, seems to induce an intracellular Mg loss. In the long run, type A individuals would develop a state of Mg deficiency, which may promote a greater sensitivity to stress and, ultimately, lead to the development of cardiovascular problems.[22]